STUDENT APPLICATION
2008-2009
APPLICATION FOR ADMISSION
Instructions: The following is an application for
admission to Living Water Christian School.
Please print legibly and fill in
All
spaces to the best of your ability. All
information disclosed would be kept in the strictest confidence.
STUDENT INFORMATION
Last Name_____________________________First
Name_________________________Middle Name___________Male_____Female______
Street Address____________________________Home
Phone_________________Cell Phone_____________SSN _____________________
City___________________________________Zip______________________DOB_________________________Age____________________
Grade To Attend___________Place of
Birth_______________________Last School
Attended______________________________________
Child Lives with:
______Father_____Mother______Stepfather_____Stepmother______Legal Guardian _____Other:_________________
PARENT/LEGAL GUARDIAN INFORMATION:
Father: ______Living______Deceased______Separated______Divorced______Remarried______Widowed(check
where applicable)
Mother:
______Living______Deceased______Separated______Divorced______Remarried______Widowed(check
where applicable)
Father/Guardian Name
_____________________________Employment/Occupation______________________
Rank___________________
Father’s/Guardian’s Work
Number____________________________Education _________________Religion_________________________
Father’s cell
phone______________________________________Father may pick up the child
Yes___________No______________
Mother/Guardian
Name_____________________________Employment/Occupation_______________________Rank__________________
Mother’s/Guardian’s Work
Number___________________________Education_________________Religion__________________________
Mother’s cell
phone______________________________________Mother may pick up the child
Yes___________No____________
Other Children in Family (names and
ages)________________________________________________________________________________
STUDENT HISTORY
Has the student ever had any serious
learning/discipline problems in school ____Yes_____No
If yes, please
explain:______________________________________________________________________________________
________________________________________________________________________________________________________
Has the applicant ever repeated a grade? What grade?__________ ____Yes ____No
Does the applicant have any learning disability, mental
or physical handicaps or IEP? ____Yes____
No
Explain:________________________________________________________________________________________________
________________________________________________________________________________________________________
Church now attending:
__________________________Pastor:______________________Phone:________________________
Are there any school or family situations the school
should be aware of? (joint custody arrangements, etc.) ____________________
_________________________________________________________________________________________________________
________________________________________________________________________________________________________
Emergency contact numbers (other than
Parents/Guardians):
1. Name:
__________________________________ Telephone: ______________________Cell
Phone:____________________
2. Name:
__________________________________ Telephone: ______________________Cell
Phone:____________________
Please notify the names listed above that if the school
calls them, they must come quickly to the school.
Living Water Christian School admits
students of any race, color, national and ethnic origin to all rights,
privileges, programs, and activities generally accorded
or made available to students at the school. It does not discriminate on the basis of
race, color, national, or ethnic origin in administration of is educational
policies,
scholarships and loan programs, and
athletic and all other school administered programs.